摘要 :
Abstract Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines ( TG 13) are used worldwide as the primary standard for management of acute cholangitis ( AC ), they need to be validated through implemen...
展开
Abstract Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines ( TG 13) are used worldwide as the primary standard for management of acute cholangitis ( AC ), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG 13 diagnostic and severity grading criteria for AC and propose TG 18 criteria. While there is little evidence evaluating the TG 13 criteria, they were validated through a large‐scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG 13 diagnostic criteria was higher than that based on the TG 07 criteria, and that 30‐day mortality in patients with a higher severity based on the TG 13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30‐day mortality among patients with Grade I or Grade III AC , but significantly lower 30‐day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG 13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG 13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG 13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG 13 criteria be adopted in the TG 18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47 . Related clinical questions and references are also included.
收起
摘要 :
Abstract The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians...
展开
Abstract The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1 st edition of the Tokyo Guidelines 2007 ( TG 07) was revised in 2013. According to that revision, the TG 13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG 13 diagnostic criteria of acute cholecystitis. On the other hand, the TG 13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG 13 severity grading for acute cholecystitis was significantly associated with parameters including 30‐day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG 13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG 18/ TG 13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47 . Related clinical questions and references are also included.
收起
摘要 :
Aim The aim of this study is to clarify the correlation of the co‐activation of β‐catenin and hepatocyte nuclear factor (HNF)4α with the findings of gadoxetic acid‐enhanced magnetic resonance imaging (MRI), organic anion tran...
展开
Aim The aim of this study is to clarify the correlation of the co‐activation of β‐catenin and hepatocyte nuclear factor (HNF)4α with the findings of gadoxetic acid‐enhanced magnetic resonance imaging (MRI), organic anion transporting polypeptide (OATP)1B3 expression, and histological findings in hepatocellular carcinoma (HCC). Methods One hundred and ninety‐six HCCs surgically resected from 174 patients were enrolled in this study. The HCCs were classified into four groups by immunohistochemical expression of β‐catenin, glutamine synthetase (GS), and HNF4α: (i) β‐catenin/GS (positive [+]) HNF4α (+); (ii) β‐catenin/GS (+) HNF4α (negative [?]); (iii) β‐catenin/GS (?) HNF4α (+); and (iv) β‐catenin/GS (?) HNF4α (?). We compared the four groups in terms of the enhancement ratio on the hepatobiliary phase of gadoxetic acid‐enhanced MRI, immunohistochemical organic anion transporter polypeptide (OATP)1B3 (a main uptake transporter of gadoxetic acid) expression and histological features, overall survival, and no recurrence survival. The Kruskal–Wallis test, Steel–Dwass multiple comparisons test, Fisher's exact test, and log–rank (Mantel–Cox) test were used for statistical analyses. Results Enhancement ratio on gadoxetic acid‐enhanced MRI in HCC with β‐catenin/GS (+) HNF4α (+) was significantly higher than those of the other three groups ( P ?<?0.001). The OATP1B3 grade was also significantly higher in HCC with β‐catenin/GS (+) HNF4α (+) ( P ?<?0.001). Hepatocellular carcinoma with β‐catenin/GS (+) HNF4α (+) showed the highest differentiation grade as compared to the other groups ( P ?<?0.004). There were no significant differences in portal vein invasion, macroscopic growth pattern, or prognosis analyses between the four groups. Conclusion Co‐activation of β‐catenin and HNF4α would promote OATP1B3 expression, and consequently higher enhancement ratio on gadoxetic acid‐enhanced MRI and higher differentiation grade in HCC.
收起
摘要 :
Objective To assess the chronological changes in urinary incontinence and urethral function before and after radical prostatectomy ( RP ), and to compare the findings of pelvic magnetic resonance imaging ( MRI ) before and after R...
展开
Objective To assess the chronological changes in urinary incontinence and urethral function before and after radical prostatectomy ( RP ), and to compare the findings of pelvic magnetic resonance imaging ( MRI ) before and after RP to evaluate the anatomical changes. Patients and Methods In total, 185 patients were evaluated with regard to the position of the distal end of the membranous urethra ( DMU ) on a mid‐sagittal MRI slice and urethral sphincter function using the urethral pressure profilometry. The patients also underwent an abdominal leak point pressure test before RP and at 10 days and 12 months after RP . The results were then compared with the chronological changes in urinary incontinence. Results The MRI results showed that the DMU shifted proximally to an average distance of 4 mm at 10 days after RP and returned to the preoperative position at 12 months after RP . Urethral sphincter function also worsened 10 days after RP , with recovery after 12 months. The residual length of the urethral stump and urinary incontinence were significantly associated with the migration length of the DMU at 10 days after RP . The residual length of the urethral stump was a significant predictor of urinary incontinence after RP . Conclusion This is the first study to elucidate that the slight vertical repositioning of the membranous urethra after RP causes chronological changes in urinary incontinence. A long urethral residual stump reduces urinary incontinence after RP .
收起
摘要 :
Purpose To quantify the acute effect of the head‐down tilt (HDT) posture on intracranial hemodynamics and hydrodynamics. Materials and Methods We evaluated the intracranial physiological parameters, blood flow‐related parameters...
展开
Purpose To quantify the acute effect of the head‐down tilt (HDT) posture on intracranial hemodynamics and hydrodynamics. Materials and Methods We evaluated the intracranial physiological parameters, blood flow‐related parameters, and brain morphology in the HDT (–6° and –12°) and the horizontal supine (HS) positions. Seven and 15 healthy subjects were scanned for each position using 3.0 T magnetic resonance imaging system. The peak‐to‐peak intracranial volume change, the peak‐to‐peak cerebrospinal fluid (CSF) pressure gradient ( PG p‐p ), and the intracranial compliance index were calculated from the blood and CSF flow determined using a cine phase‐contrast technique. The brain volumetry was conducted using SPM12. The measurements were compared using the Wilcoxon signed‐rank test or a paired t ‐test. Results No measurements changed in the –6° HDT. The PG p‐p and venous outflow of the internal jugular veins (IJVs) in the –12° HDT were significantly increased compared to the HS ( P < 0.001 and P = 0.025, respectively). The cross‐sectional areas of the IJVs were significantly larger ( P < 0.001), and the maximum, minimum, and mean blood flow velocity of the IJVs were significantly decreased ( P = 0.003, < 0.001, and = 0.001, respectively) in the –12° HDT. The mean blood flow velocities of the internal carotid arteries were decreased ( P = 0.023). Neither position affected the brain volume. Conclusion Pressure gradient and venous outflow were increased in accordance with the elevation of the intracranial pressure as an acute effect of the HDT. However, the CSF was not constantly shifted from the spinal canal to the cranium. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:565–571.
收起
摘要 :
Background Analysis of portal venous flow (PVF) is important when evaluating the severity and prognosis of liver disease. PVF might be altered by postural changes (ie, difference in the effects of gravity). Purpose To evaluate the...
展开
Background Analysis of portal venous flow (PVF) is important when evaluating the severity and prognosis of liver disease. PVF might be altered by postural changes (ie, difference in the effects of gravity). Purpose To evaluate the effect of gravity on PVF using a novel MRI system, which can obtain abdominal MRIs in both the supine and the upright positions. Study Type Prospective self control. Subjects Twelve healthy young male volunteers. Field Strength/Sequence Caval velocity‐mapped images were obtained using the electrocardiography‐triggered cine phase‐contrast technique in the supine and upright positions with multiposture MRI (paired 0.4 T permanent magnets). Assessment The mean PVF velocity in the region of interest in each cardiac phase was determined. A PVF curve in the cardiac cycle was also obtained from the PVF velocity multiplied by the cross‐sectional area. The mean PVF velocity, maximum PVF velocity, cross‐sectional area of the PV, mean PVF, maximum PVF, and heart rate in the supine and upright positions were assessed. Statistical Tests Wilcoxon signed‐rank tests were applied. P < 0.05 was considered statistically significant. Results The mean PVF velocity, maximum PVF velocity, cross‐sectional area of the PV, and maximum PVF were all significantly lower in the upright position compared with the supine position ( P = 0.002 for all), with differences of 42% ± 15%, 38% ± 12%, 60% ± 17%, 24% ± 11%, and 22% ± 9.3%, respectively. However, heart rate was significantly higher (116% ± 9.2%, P = 0.003) in the upright position compared with the supine position. Data Conclusion The effect of gravity during postural change from a supine to an upright position significantly decreases the PVF. Multiposture MRI allows acquisition of more detailed information on liver function. Level of Evidence : 2 Technical Efficacy Stage : 1 J. Magn. Reson. Imaging 2019;50:83–87.
收起
摘要 :
Abstract Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and hel...
展开
Abstract Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 ( TG 13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 ( TG 18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG 18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG 18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47 . Related clinical questions and references are also included.
收起
原文获取